Harvard Pilgrim has developed a prior authorization policy for the new-to-market drug Radicava. The FDA approved Radicava (edaravone) in May 2017 to treat patients with amyotrophic lateral sclerosis (ALS). Effective for dates of service beginning Dec. 15, 2017, Harvard Pilgrim will cover Radicava for the treatment of ALS with prior authorization, when the criteria outlined in the new policy have been met.
As a reminder, CVS Health–NovoLogix oversees our prior authorization program for medical drugs to optimize treatment outcomes and promote the safe and cost-effective use of these medications. To request authorization for Radicava, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For complete information, please refer to our new Radicava Medical Review Criteria.